In his latest blog post for Social Care News, ADASS President David Pearson robustly defends government and sector partners’ pursuit of better integrated health and care, whilst recognising the tough challenges ahead. Now, he believes, is the time for focus and resolve - even as an approaching election year generates its own uncertainties…
Rumour and speculation have nothing on the totally familiar machinations scurrying about on the fringes of the Better Care Fund (BCF) this past fortnight. There have been two accusations flying round the media – print, broadcast and digital/social. The first was an assertion the BCF transfer was going to be delayed because significant doubts had been raised about whether or not the transformation and the desired savings will, in fact, be achieved.
This caused a great deal of consternation and there is a danger that, as health and social care commissioners and providers set about achieving changes never previously attempted at such scale, confidence and resolve might be undermined.
I was personally contacted by not a few bewildered ADASS members and colleagues from the health service asking what on earth was going on. The ADASS office also. I can only imagine how many hits the Department of Health (DH) received during the course of that day, especially as the newspaper concerned helpfully stacked up what was a fairly rapidly rebutted story with another article applauding the prospect of delay.
DH said: "successive governments and leading health professionals have talked about joining up health and social care for decades. The Better Care Fund is a major step to making this a reality and transforming the way people are cared for closer to home. We have set aside time to make sure all areas have developed comprehensive plans for joined up care. The Better Care plans start from April 2015, and we asked for early versions to be completed a year in advance so we could review them, check their level of ambition and test how they would be delivered. This is what is happening now."
So what lies behind this, when we might otherwise be celebrating the way in which health and local government have shown their ambition in the last year in over a 100 bids to become pioneers? This at a time when Clinical Commissioning Groups and Health and Wellbeing Boards were still a few months old? Perhaps it was an honest failure of communication between government and newspapers – it happens. We all make mistakes.
Most observers argue that health and care should provide joined up, person-centred care based around the individual (National Voices). And a number of studies and reviews have consistently concluded that a significant number of older people and working age adults with long term conditions would not need to be in hospital if community health and social care were bolstered enough to be able to provide effective proactive care for a new generation enjoying greater longevity, but who, as a consequence, have greater needs.
Clearly, many hospitals are worried about their long term survival and short term solvency, while others lack confidence that changes can be achieved or the reductions in hospital beds will be tolerated by the public - or ultimately, supported by politicians.
It is perhaps a reasonable concern that such major changes can be achieved in very short timescales or without some degree of double funding to put new services in place. If we are to ensure integrated services don’t cost more and save money, then planning has to be discerning and the impact carefully reviewed.
This issue will no doubt continue to be a central debate as we approach the general election next year. A reasonable debate about such important priorities is one of the benefits of a democracy. There is no doubt this is difficult. The financial climate could hardly be colder and joining up funding is no panacea for all the funding challenges in social care or health.
I have seen joined up services at their best when local areas determine that they are going to make a difference, when organisational interests can be set aside, leaders can learn to walk in each others' shoes and the focus is on the needs of the population. There is a huge opportunity to develop person-centred, local planning through Health and Wellbeing Boards.
The second, related but very, very different story came from research published by MHP Health, a heavyweight lobbying/communications group. Its report, All in this together?, essentially suggested that in some areas money apparently transferred to bulk up preventative services was being used to plug gaping holes in other, non-preventative parts of the adult social care budget. It was supported by a favourable foreword by Richard Hawkes from Scope and the Care and Support Alliance, which he chairs.
This, in a way, was a more serious development: more research-based and potentially less political in its provenance. And for a while the temptation was to keep our heads down; avoid the flack. But then frankly, that wouldn’t do. We need to reassert vigorously that the intention behind the BCF is fully consistent with all the research we have. And remember: £1.1 billion of it was allocated precisely to do what MHP criticises it for doing: to ensure that vital and essential social care services can be provided - perhaps not in the same way. But the level of innovation I have seen across social care in this country has set a benchmark for others to follow.
Backing up social care services is a crucial part of prevention as are the monies specifically earmarked for that purpose. As a colleague in the Local Government Association put it so well: most local authorities have tried to protect social care services as much as possible, despite significant budget cuts as witnessed by our ADASS budget survey results.
Running with the BCF will not be easy. We are 152 top tier local authorities and some 211 CCGs tackling these issues from different bases with widely differing economic, geographical and demographic requirements. The need for the engagement of providers in the local provision is paramount. What is imperative in turbulent times is to keep focused on our purpose. With the evidence from the critique of the health and social care system to the widely expressed desire by citizens to have their care joined up in the community, leaving hospitals to do what they do best: save lives.
Perhaps it is this focus that will enable leaders both nationally and locally to be brave enough to take the bold steps necessary to make the changes to a system that is in danger of lagging behind the demands upon it and the expectations of the people who pay for it. It will leave people better cared for, with more choice and control. It is one essential ingredient of ensuring that we have world-class services to help us face the growing needs in our communities.
The views expressed in this and other posts on this site are those of named authors and do not necessarily reflect the views of the Department of Health